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Facet Arthropathy

What Is It, Causes, Signs and Symptoms, and More

Author: Maria Emfietzoglou, MD

Editors: Alyssa Haag, Ian Mannarino, MD, MBA, Kelsey LaFayette, DNP, RN, FNP-C

Illustrator: Jessica Reynolds, MS

Copyeditor: Stacy M. Johnson, LMSW

What is facet arthropathy?

Facet arthropathy refers to the swelling and tenderness of the facet joints, which are joints in the spine, or spinal column, that allow for twisting, bending, and proper alignment of the back. The facet joint contains a synovial membrane, synovial fluid, and hyaline cartilage surfaces and is surrounded by a fibrous joint capsule. Facet arthropathy of the lumbar spine typically occurs in older adults and is often characterized by chronic back pain. It is most common in older individuals and those with high body mass index (BMI). Individuals may seek immediate medical advice as this condition can negatively impact their quality of life. 

What causes facet arthropathy?

Facet arthropathy is caused by conditions that result in wear and tear on the facet joints, such as aging, repetitive stress on the joints, poor posture, and obesity. Other causes for developing facet arthropathy include traumatic injuries involving the spine (e.g., motor vehicle accidents) and synovial cysts, which are atypical, fluid-filled sacs that can develop in the spinal joints, typically due to aging. Moreover, facet arthropathy often occurs in osteoarthritis, also known as degenerative joint disease, a chronic, non-inflammatory condition characterized by gradual wear and tear of joint cartilage and underlying bone, causing joint pain and stiffness.  

What are the signs and symptoms of facet arthropathy?

Lumbar facet arthropathy is most prevalent at the L4-L5 and L5-S1 spinal levels. Signs and symptoms of facet arthropathy include back or neck pain, depending on the affected facet joint's location, which worsens with twisting, standing, or bending backward. The pain is typically centered on one specific part of the spine; however, it can sometimes present as a dull ache on both sides of the back. The affected joints may become enlarged, exerting pressure on nerve roots and causing pain radiating down the lower extremities. Facet arthropathy pain is typically relieved by bending forward as the pressure on the facet joints decreases. 

Over time, facet arthropathy can lead to complications, such as osteophytes (i.e., bone spurs), which are small bony projections that narrow the spaces in the spine available for the passage of nerve roots, thereby causing spinal stenosis and potentially neuropathic pain. 

How is facet arthropathy diagnosed?

Diagnosis of facet arthropathy typically starts with a thorough patient history and physical examination.  Imaging tests can also be performed, including MRI, CT scan, or X-ray, to evaluate the spine and identify evidence of facet joint degeneration. Injection of anti-inflammatory steroids into the facet joints can also assist in confirming the diagnosis. If symptoms are relieved after the injection, then it is likely that the individual has facet arthropathy. 

How is facet arthropathy treated?

Treatment of facet arthropathy focuses on supportive management of pain and typically includes anti-inflammatory medications (e.g., aspirin, ibuprofen); application of heat or ice packs on the affected area; and physical therapy to strengthen the affected muscles. Movements that aggravate symptoms, such as twisting, lifting, or lower back extension, may be advised to avoid. Other treatment options to manage the pain include radiofrequency ablation and shockwave therapy to destroy the affected nerve fibers and block pain signals. In severe cases, reconstructive surgery may be recommended to remove the affected joints.

What are the most important facts to know about facet arthropathy?

Facet arthropathy is a type of arthritis affecting the facet joints of the spine and causing chronic back pain. Causes include various conditions that lead to wear and tear of the affected joints, such as advanced age and traumatic injuries. Diagnosis is based on patient history, physical examination, and imaging tests. The treatment plan focuses on managing symptoms and can include anti-inflammatory medications, physical therapy, destruction of affected nerve fibers, or surgery if needed. 

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